Volunteers could be screened for the most high-risk comorbidities, and older volunteers should be female, since we’re at lower risk than males. Older volunteers should be thinner and fitter and have lower cholesterol and blood pressure than the average American 20-something.
Eyal had originally suggested that whether the vaccine worked, volunteers would leave these studies with protective antibodies and the gift of immunity — something that’s become much-coveted in the age of Covid-19. But immunity to this new disease is not well understood, so the dream of “immunity passports” won’t become a reality anytime soon. At the very least, volunteers could test the protective value of these natural antibodies.
That’s something I learned from Plotkin. He said that even before vaccine trials began, human volunteers who tested positive for antibodies could participate in experiments where they got exposed to small doses of the virus to find out if these antibodies were indeed protective.
Since the amount of virus you’re exposed to might affect the course of disease, the doctors would want to use the minimum amount needed to develop symptoms in order to minimize risk.
I’ve already canvassed some experts who say a challenge wouldn’t necessarily be riskier than getting the virus out in the world, as most of us probably will without a vaccine. It might even be safer, since volunteers would likely be supervised and treated early with the best standard of care. There is a slight risk of something called antibody-dependent enhancement — in which the vaccine actually helps the virus get into cells. Something like that happened with a dengue vaccine, but you’d have to be extremely unlucky for it to happen in this case without showing up in animal studies.
Though some ethicists have debated paying volunteers, this would be a mistake. It would lead to the perception that the scientists were preying on those who need money. Nobody should participate in this kind of trial for the money.
But we should also recognize that, unlike a kidney donation, participation in Covid-19 vaccine trials wouldn’t be purely altruistic, either. Unlike kidney donors, volunteers would benefit from being perhaps the first to feel safe from the disease. They’ll also share in the collective benefit accrued from a broader return to a normal life when more of us have the freedom to move about, do our jobs, and find love and companionship.
There’s always the possibility that something unpredictable could go wrong — and that could lead to a public-relations nightmare that could derail vaccine research. But the bad PR might be worse if something happened to an innocent young person than to a considerably older, wiser, more informed person who knew what she was walking into.
Little about America’s approach to the pandemic has been ethical to date. We weren’t given informed consent about the lockdowns — many people don’t understand their purpose, or their limitations. There’s also been little informed consent on lifting them — it’s not clear whether people understand that the risk of contracting Covid-19 remains as large as ever in the U.S.
The lockdowns only delay deaths from the virus. A vaccine would end them. Surely that’s a reward for which some of us are willing to risk ourselves.
Faye Flam is a Bloomberg Opinion columnist. She has written for the Economist, the New York Times, the Washington Post, Psychology Today, Science and other publications. She has a degree in geophysics from the California Institute of Technology.